Part four of a four part series
Because of the popularity of the Elequil aromatabs® brand, aromatherapy made for the clinical setting, we are often asked how others successfully achieved adaptation of an aromatherapy initiative.
As a result, Beekley Medical teamed up with Worldwide Business Research to present a webinar that included the expertise and experience of three panelists using aromatherapy within their role at their hospital.
During the webinar, there was an abundance of questions for the panel on how they implemented aromatherapy at their facility. Since others in healthcare have the same questions we compiled the panelists' answers into a blog series for others seeking guidance on how to build a successful aromatherapy initiative as a non-pharmacological approach.
In this installment, the panelists discuss how what they wish someone had told them before getting started with an aromatherapy initiative and other other questions fielded by the webinar audience.
Meet the panelists:
• Alicia Plumer, MSN, RN, CPAN, Nurse Manager, PACU at Woman’s Hospital in Louisiana
• Niels Tobiasson RN, BSN, OR Nurse/Surgery at a large hospital HCS in Texas
• Kristine Kowalski BSN, PHN, MA, CHPCA, Palliative Care Coordinator at Mission Hospital, CA
Q: What do you wish someone had told you before getting started?
Alicia: We were very much so interested in doing research on aromatherapy for our postoperative patients as well as the obstetric population. There is a lot of research out there for postoperative use, however there is a very limited amount of research for obstetric patients. So I would have liked more support in setting up this up as a research project.We do have a process in place and an IRB board, but it can be a bit cumbersome, which would have delayed our implementation. And so that's why we, decided to proceed with the implementation and then tried to find out how we could turn this into some sort of research after the fact.
Niels: The biggest thing for me was I didn't realize because I'm new to this whole idea of implementing a new intervention or a new product, just how much extra work and what all it entails.
I originally thought that I would have the idea and within a month I'd find the product, get it going, and start helping patients immediately. However, because it's a big system and we want this intervention to stick so that it can help patients for the future, it took a lot of extra meetings, a lot of buy-in, a lot of extra time that I wasn't anticipating. So the biggest thing I wish someone would've just mentioned, Hey, you know, this might take six months or a year instead of a month.
Kristine: I think one of the most important things I wish someone had provided was the importance of having a high quality product. Products that are 100% pure essential oils. When the healthcare system approached me about cost cutting measures, and again, there's 51 hospitals within the healthcare system, they were looking obviously at finances and looking at the cost analysis.
It took several weeks to go through eliminating products because of the various additives that were included in those products. It could have been done so much quicker and with less frustration felt by several of my associates trying to just justify a pure high-quality product. It took resources like the Joint Commission standards before the system really took a look at what we were offering and suggesting as professionals as the the type of product you need to have for these patients.
Q: What changes did you have to make to charting your aromatherapy program?
Niels: Epic is the system that we use. In the GI systems setting area, there's a dropdown button that you can push. It is already built into the system. When you go into the GI section, it asks if it defines limits and if not, you can hit no and it brings up what interventions are used to help with it and one of the options is already built in as aromatherapy. I really didn't need to add anything into our charting system. I just needed to help show the nursing staff where to go to, to find it.
Kristine: We don't currently have Epic yet, but we are heading in that direction. Currently what the nurses do is they just free text it. Often they would do it in the patient satisfaction portions of their care plans and in the drop downs they do have a comment section and they would indicate that aromatherapy products have been provided for comfort measures.
Alicia: We have a screen in our documentation where all pain and discomfort is documented. Whether that be for pain, queasiness, vomiting, what not. Those are some of the most common options and within that documentation screen, the nurses would chart what the symptoms were that the patient's having, the severity of the symptoms and then the interventions that were performed to address it. We did have aromatherapy added as an option, as an intervention. Once we added it and we then educated the nurses and it was pretty simple.
Q: Do you have any recommendations in terms of products or training for nurses regarding aromatherapy?
Kristine: Ah, this is the most important part of training - the process of learning how to properly apply the product. There are different manufacturers out there and you just need to follow the instructions to get the benefits by picking the scent levels – whether minimum or maximum and how to properly tearing to expose the scent.
I recommend reading the manufacturer's instructions or having that personal, representative from the whatever manufacturer you choose to show you how to adequately use the products that are usable for patients and their families.
Niels: One thing that I've noticed when I was training staff on how to use the aromatherapy was just repetition and that every single person learns differently, so when I would try to teach one person by using an email, it wasn't really the best method for them. They learn by doing it. That's the thing that I learned- to just use a lot of different methods to teach. So that way everyone, whatever way they learn best, is able to receive that education.
Alicia: Similar to Niels, we use a multi-factor approach with our training for the nurses. We use an online computer module system which is always helpful to get information out quickly to the mass number of nurses. This product needed to be touched, so the vendor was able to provide us with instruction for use and training videos which we uploaded and had all of the nurses complete through that online computer module system.
The vendors also came onsite and worked with the clinical educators and one-on-one with nurses by doing unit to unit in-servicing - just really a multi-factoral approach.
Q: Was FDA regulation a roadblock?
Niels: It was not a road block at all for my hospital. One thing that I was told was that because it's not a medication, which would have made it more complicated, but rather a simple nursing intervention, we didn't have really any issues with the FDA at all.
Alicia: Like Neil said, because it's not classified as a medication, it's actually stocked in our materials management department and distributed like a supply. So, we really didn't have any issues with that.
Kristine: It did not require going through our general pharmacy. It’s just on supply, it was very easily to get the product since it is not a medication and without any concern of a federal regulation.
Q: Were any patients excluded from aromatherapy use?
Kristine: We are very cautious with our pulmonary patients, especially if they do tend to be more sensitive to any scents. We will present it at a distance and just try to determine whether it would be a benefit for them or not. Often the families will be the ones telling us upfront that, you know, any type of a scent will cause distress. So often we will cautiously approach with our pulmonary patients, but that's probably the only classification of an illness that we come in with a different perception of whether these products are going to be beneficial or not.
Alicia: We don't treat a ton of patients with any type of pulmonary complications. However, we did not build any specific restrictions into our procedure, but what we did do is establish steps of the procedure for the nurse to make sure that the patient doesn't have any allergies that would be affected by the product. And also to obtain verbal consent from the patient.
It's not just pulmonary complications, but some patients may be sensitive to certain smells or certain scents. They know best what they're able to tolerate and not. So first and foremost, they offer it to the patient, get verbal consent, and then give the patient a preference of which cent option they prefer to use.
Q: Can anyone discuss some specific examples of how it affected pain?
Kristine: I would say probably 80% of my patients are cancer patients. And, most of our patients when we do an assessment when they initially come in to the clinic, usually within 48 hours of being released from the hospital, where they had been receiving opioids. Whether they're compliant or not with them at home, they are all coming in with a pain level anywhere between 8 to 10, which is on the high side.
Those initial visits will take anywhere from an hour to two hours depending on the needs of the patient and the family dynamics. We will have the patients do a reassessment after interventions and every intervention will initially start with an aromatherapy product if they're complaining of pain. And we do see an improvement without any administration of any standard medications. So it truly does provide comfort for pain.
What I'm being told by patients and their families if they are still taking pain medication, they are decreasing the quantity and the frequency of having to use those pain medications if they're using it in conjunction with the aromatherapy products.
Niels: So for myself in the operating room, we've mainly focused on queasiness and anxiousness which I'm grateful for the hospital allowing me to make this change. But we haven’t focused on pain yet.
Alicia: That would be the same for us. We are mostly focusing on queasiness, anxiousness, and relaxation.
Q: Are the patients charged in any way for use of the aromatherapy product?
Alicia: Anytime we bring a new supply into the hospital, we do have a process for checking to see if it's a chargeable item or not. We did submit the aromatherapy products to our chargemaster gurus in accounting and they run it through. I'm a nurse and so I’m not aware of exactly what the system is that they use, but they run it through a system where it's cross check to see if it's a chargeable item or not. And we were able to charge for the product.
Niels: We do not charge our patients. It's just included in the package for the patient being brought to the operating room in either in Pre-Op, PACU or the OR. I have noticed though that because it is helping with the patients not vomiting, that it's increasing throughput at times. They're able to get out of the hospital faster. We're not having to charge as much medications to the patients. So it's saving us in the long run even though we're not charging the patient.
Kristine: Similar to Niels, this is a courtesy product that we offer to patients throughout the hospital primarily in the palliative system. What we have identified is the satisfaction questionnaires that get sent to patients’ post-hospitalization or post-clinic visits, they identify specifically the satisfaction they have with just being offered aromatherapy since it's such a simple product, that they are eager to return, and definitely suggest other patients and family members utilize the care at the facilities because of that personalization and just the sincerity of offering them something so simple, but yet so beneficial.
Beekley Medical would like to thank our guest expert panelists for sharing their knowledge that will help so many others increase their level of care through a non-pharmacological approach.
To learn more about Elequil® and the use of aromatherapy in the clinical setting, visit Elequil.com. To request materials for a trial evaluation at your clinic, contact your Elequil Account Manager at 1-800-233-5539 or firstname.lastname@example.org.